Download Spring 2015 Saint Louis University School of Medicine USING A

GrandRounds
Spring 2015
Saint Louis University School of Medicine
USING A TEAM APPROACH, THE LATEST TECHNOLOGY AND THE NEWEST TREATMENTS,
the School of Medicine’s Liver Specialists are earning their reputation as the best in the country.
New OB-GYN Chair Appointed
Teaching Students to Recognize Bias in Order to Become Better Doctors
From the Dean | One of the major goals of basic
science in medicine is to develop treatments that benefit
patients. Such clinical translational science requires
communication, cooperation and collaboration between
laboratory scientists, clinical scientists, clinicians and
surgeons and others who focus on improving a particular
type of human malady. The Saint Louis University story in
the fight against liver disease exemplifies what can be
achieved when such collaborations succeed.
Nearly 30 years ago, when people like Drs. Bruce Bacon
and Adrian Di Bisceglie were getting started, the world
knew relatively little about viral hepatitis. Many patients
were virtually asymptomatic until their liver dysfunction
was advanced, and then the resultant cirrhosis and possible
secondary liver cancer often were debilitating or fatal.
Now, the viral causes and clinical course of hepatitis are
better understood and highly effective treatments have
been developed. In the case of hepatitis C, a great deal of
the progress has been made right here at SLU. This issue
of Grand Rounds shows how the work of SLU’s liver team
led to a cure for one particular patient, but she is just one
of thousands who have been helped.
SLU’s achievements in hepatic disease therapy exemplify
the importance of team medicine. The story on Dr. Michael
Railey’s work to embed cultural competency in the medical
school curriculum provides future evidence of the benefits
of people working together. These lessons have had special
importance at SLU in the months following the Ferguson
protests over the shooting of Michael Brown. Ferguson
is a suburb of St. Louis about 13 miles from SLU. SLU’s
main campus became involved when a peaceful protest
march moved through the main campus and several of the
protesters pitched tents and stayed several days. President
Pestello has been widely praised for peacefully persuading
these protesters to leave. Such approaches resonant strongly
at the medical campus. To be great physicians we and our
students must have the same empathy for all patients and
at least enough cultural competence to communicate with
all patients effectively. So whether our teams are focused on
something as specific as hepatitis or whether they’re focused
on bringing people together in a much broader sense, healing
is a critical SLU value - a value that we pursue daily in our
clinical work, education and research. I hope that you’ll have
the opportunity to visit us soon to learn more about how SLU
professionals and students live out these values every day.
Grand Rounds is
published biannually by
Saint Louis University
Medical Center
Development and
Alumni Relations.
Marsha Hensley
(front right) with
members of the
abdominal transplant
team (circling from left to
right): Alex S. Befeler,
M.D., associate professor
of internal medicine
and medical director
of liver transplantation;
Alexandra Voinescu,
M.D., assistant professor
of internal medicine and
transplant nephrologist;
Donna Kirkpatrick,
R.N., post-liver transplant
coordinator; Tom Allen,
business manager of the
abdominal transplant
program; Mustafa
Nazzal, M.D., assistant
professor of surgery;
Ginny Davis, R.N.,
B.S.N., clinical practice
manager; Karen Johns,
R.N., M.S.N., pre-liver
transplant coordinator;
Henry B. Randall, M.D.,
F.A.C.S., associate
professor of surgery
and director of liver
transplantation.
Grand Rounds is mailed
to alumni and friends of the
School of Medicine.
Philip O. Alderson, M.D.
Dean|Saint Louis University
School of Medicine
Vice President|Medical Affairs
Schwitalla Hall M268
1402 S. Grand Blvd.
St. Louis, MO 63104-1028
GRAND ROUNDS EDITORIAL BOARD
Philip O. Alderson, M.D.
Edward J. O’Brien Jr., M.D. ’67
Cheryl Byrd
MAGAZINE CONTRIBUTORS
Coordinator and Writer|Marie Dilg|SW ’94
Designer|Jamie Klopmeyer
Laura Geiser|A&S ’90|Grad ’92
Nancy Solomon
Carrie Bebermeyer|Grad ’06
page 6
PHOTO AND ILLUSTRATION CREDITS
Steve Dolan|front cover, 1, 6-10, back
Kevin Lowder|5, 12-15
Kabance Photo|16-17
SCHOOL OF MEDICINE EXECUTIVE ADVISORY BOARD
President|Edward J. O’Brien Jr., M.D. ’67|St. Louis
Edward C. Chen, M.D. ’05|Kirkwood, Mo.
James Junker, M.D. ’79|St. Louis
Laurence Kinsella, M.D. ’85|Fenton
Gary A. Maassen, M.D. ’86|St. Louis
Marsha McBride, M.D. ’95|St. Louis
Gloria Merenda, M.D. ’82|St. Louis
Ellen Nicastro, M.D. ’04|St. Louis
Joseph Ojile, M.D. ’84|St. Louis
Terrence Piper, M.D. ’75|St. Peters, Mo.
Christopher Spencer, MD. ’10|St. Louis
© 2015, Saint Louis University
All rights reserved
GrandRounds
Saint Louis University School of Medicine
Vol. 13
A Gifted Plan
A $6.6 million gift supports the School of Medicine’s efforts to improve health care for patients
from communities in need by training for primary care physicians.|page 5
No.1
SPRING 2015
Vital Signs page 2
Match Day 2015 page 16
Well Deserved Reputation
Program and procedural changes in the Center for Abdominal Transplant result in improved
patient care and robust referrals. |page 6
New OB-GYN Chair
Philip O. Alderson, M.D.
Dean | Saint Louis University School of Medicine
Vice President | Medical Affairs
20 GrandRounds
For more information about
the magazine or to submit story
suggestions, please contact
314 -977- 8335 or
[email protected].
Mary McLennan, M.D. is new to the position but not to the department, and she hit the ground
running.|page 12
A Wide Lens
Medical students explore bias within themselves, their patients and their communities in order
to become better physicians.|page 14
Alumni Pulse page 18
Saint Louis University School of Medicine 1
VitalSigns
Resetting Internal
Clocks
BURRIS
A Saint Louis University
researcher has found a
small molecule that directs
the activity of key “clock
proteins” that may offer
the potential to manage
circadian rhythm and treat
problems associated with its
dysfunction, such as sleep
and anxiety disorders.
In research funded by
the NIH and published
in Nature Communications,
Thomas Burris, Ph.D.,
chair of pharmacological
and physiological science,
reports on his research that
targets a protein called REVERB, which appears to play
a pivotal role in regulating
mammals’ internal clocks.
In mammals, the internal
clock that maintains circadian rhythm is essential for
normal physiological functions. The rhythms, however,
can be disrupted. Dysregulation of circadian rhythm
is associated with many disorders, including metabolic
disease and neuropsychiatric
disorders including bipolar
disorder, anxiety, depression,
schizophrenia and sleep
disorders.
“It’s been suggested that
REV-ERB is a core component of our clock,” Burris
said. “Mice without it are
arrhythmic. This study
demonstrated that when
we give mice a synthetic
compound that turns
REV-ERB on, it altered their
circadian rhythm.”
Burris and his colleagues
examined effects of the
compound on patterns of
sleep and wakefulness and
found that it increases wakefulness, reduces REM and
slow-wave sleep, and, notably, decreases anxiety. This is
especially interesting, Burris
said, because drugs that
increase arousal frequently
increase anxiety.
Further, the compound
appears to be associated
with a suppression of reward-seeking behavior. Drug
addiction has a circadian
component, and mice with
mutations in genes that
affect their internal clocks
have altered responsiveness
to the reward associated
with cocaine, morphine and
alcohol. Burris speculates
that the REV-ERB-targeted drug effect on the
clock would modulate reward-seeking behavior, and
may be leveraged to help in
the treatment of addiction.
Promise for Type 1
and Type 2 Diabetes
Treatment and
Prevention
Researchers in the
department of
pharmacological and
physiological science
have made significant
discoveries that could lead
to better treatments for
type 1 and type 2 diabetes.
In a study published in
Molecular Metabolism, Andrew
Butler, Ph.D., professor
of pharmacological and
physiological science, and
his team discovered the
peptide hormone adropin.
Adropin is a hormone that
regulates whether the body
burns fat or sugar during
feeding and fasting cycles.
It can improve insulin action
in obese, diabetic mice,
suggesting that it may
work as a therapy for
type 2 diabetes.
According to the American
Diabetes Association, 29.1
million Americans have
diabetes, while 86 million
Americans age 20 and
older are thought to have a
‘pre-diabetic’ condition that
includes increased fasting
glucose and/or “impaired
glucose tolerance.”
“Adropin is a poorly understood hormone,” Butler
said. “We knew it played a
role in maintaining metabolic health, but we didn’t know
much beyond that.”
In another recent paper
published recently in Diabetes,
Butler and team offered a
first definition of adropin’s
functions that maintain
metabolic health. “When we
measured adropin levels in
mice, they were suppressed
under fasting conditions and
stimulated after feeding, suggesting functions related to
the changes in metabolism
that occur with feeding and
fasting,” Butler said. “Our
work suggests that adropin
plays a role in regulating
metabolic homeostasis.
“Basically, when you are
well fed, your body prefers
to use glucose, and the
release of adropin supports
this change by enhancing the
use of glucose as a metabolic fuel in muscle. However,
when you are fasting, your
body prefers to use fatty
acids. Our observations
suggest that a decline in
adropin with fasting may be
a signal to ‘take the brakes
off ’ the use of fatty acids.”
Building on that work,
the Molecular Metabolism paper
reports that low levels of the
hormone observed in obesity may contribute to diabetes
and the reduced ability of
the body to use glucose.
The team found that
treatment with adropin
improved glucose tolerance,
enhanced insulin action and
improved metabolic flexibility toward glucose utilization
in situations of obesity and
insulin resistance.
“The hope is that adropin could someday be used
in the clinic to help patients
with type 2 diabetes control
blood sugar levels and delay
or prevent the development
of the disease in at-risk individuals,” Butler said.
Another team in pharmacoligical and physiological
science has found a way to
prevent type 1 diabetes in
an animal model. Chairman Thomas Burris, Ph.D.,
and his team focused on
blocking the autoimmune
progress that destroys beta
cells and leads to diabetes,
with the aim of developing
therapies that can prevent
the illness from developing
rather than treating
its symptoms.
“None of the animals on
the treatment developed diabetes, even when we started
treatment after significant
beta cell damage had occurred already,” said Burris,
whose NIH-funded research
findings were published in
Endocrinology. “We believe
this type of treatment would
slow the progression of type
1 diabetes in people or
potentially even eliminate
the need for insulin therapy.”
Another Option for
Treating Marfan
Syndrome
A new
treatment
for Marfan
syndrome, a
rare genetic
disease that
can
lead
SHARKEY
to heart
problems, works as well as
the currently recommended
medical therapy, beta
blockers, according to an
article in the New England
Journal of Medicine.
Angela Sharkey, M.D.,
professor of pediatrics,
and a study author, said
researchers found losartan,
which had been effective in
an animal model of Marfan
syndrome, was equally effective to a high dose of the
beta blocker atenolol.
“While there may be
certain patients who respond better to one drug
or another, we found no
evidence that losartan is
superior to atenolol, a beta
blocker currently prescribed
for Marfan syndrome,” said
Sharkey, who was honored
last year as the St. Louis
Marfan Foundation’s Hero
with a Heart. “Losartan
appears to be a reasonable
alternative treatment for
patients who can’t take beta
blockers, which could give
physicians another option to
treat a rare and debilitating
genetic disease.”
Both medications are
designed to relax the blood
vessels so the heart doesn’t
have to work as hard to
pump blood through the
body. Atenolol slows the
heart rate, which decreases
blood pressure, and losartan
prevents certain natural
substances in the body
from tightening the blood
vessel walls.
For three years, the
multi-site, NIH-funded
trial followed 608 patients
between ages 6 months and
25 years who had enlarged
aortas. All received either
losartan, the investigational
medication, or a higher dose
of atenolol than typically
is prescribed.
Patients in both treatment groups showed no difference in the rate of growth
of their aortas. Additionally,
the incidence of aortic-root
surgery, aortic dissection or
death did not differ between
treatment groups.
Glaucoma Drug
and Weight Loss
Combo Tested to
Restore Vision
In an NIH-funded clinical
trial led at Saint Louis
University by professor
of ophthalmology Sophia
Chung, M.D., researchers
aim to bring sight back to
those who have lost vision
due to idiopathic intracranial
hypertension (IIH).
IIH is a condition of unknown origin causing raised
intracranial pressure, primarily in obese women. Those
second arm of the study,
researchers will see whether
this drug and weight loss approach is a winning combination to manage symptoms
over the long term.
CHUNG
with IIH suffer debilitating
headaches, and because of
pressure on the optic nerves,
86 percent develop some
degree of vision loss.
Approximately 100,000
Americans have IIH, and the
number is rising. Of those
with the disease, only 3 percent are men, and most are
women of childbearing age.
“IIH can significantly
diminish quality of life,”
said Chung, who also is a
SLUCare physician and a
director of the American
Board of Ophthalmology.
Researchers at 38 sites
tested whether a drug previously used for glaucoma and
used for altitude sickness, acetazolamide, could improve
mild vision loss when added
to a weight loss program.
At the beginning of the
study, the average BMI of
participants was 40. All
of those in the study were
enrolled in weight loss plans
aimed at losing six percent
of their starting weight.
Participants cut salt intake
and 500 to 1,000 calories a
day, consulted with a weight
loss coach, and were provided with simple exercise
equipment.
The vision of patients
receiving the drug improved
by twice as much as those
who received the placebo.
Participants who both lost
weight and took the medication had greater improvements in daily function and
quality of life.
The NIH’s National Eye
Institute shared results from
the first arm of the study
earlier this year. Now, in the
Scientist Aims to
Improve Antibiotics
to Treat Staph
Infections
In research
published in
Proceedings
of the
National
Academy of
Sciences, assisYAP
tant professor
of biochemistry and molecular biology, Mee-Ngan
F. Yap, Ph.D., discovered
new information about how
antibiotics such as azithromycin stop staph infections,
and why staph sometimes
becomes resistant to drugs.
Her evidence suggests
a universal, evolutionary
mechanism by which bacteria elude this kind of drug,
offering scientists a way to
improve the effectiveness of
antibiotics to which bacteria
have become resistant.
Sequence-specific inhibition of protein synthesis by
macrolide antibiotic that binds inside the ribosome tunnel
on the bacterial large ribosomal subunit (grey). Translating
nascent polypeptide is shown in blue with the tRNA attached.
Red molecule shows the macrolide antibiotic, azithromycin.
Courtesy of the Journal of Molecular Metabolism.
2 GrandRounds
Saint Louis University School of Medicine 3
Yap and her research
team studied the way
antibiotics work within the
ribosome, the site where
bacteria translate the genetic
codes into protein. When
staph bacteria encounter a
potential problem in copying
genetic material, as posed
by an antibiotic, they thwart
antibiotic inhibition by
means of “ribosome stalling”
that is mediated by special
upstream peptide elements.
As the bacterium’s
ribosome copies the strings
of genetic code, it stalls and
promotes rearrangement
of messenger RNA that
activates downstream translation of resistance protiens.
Many resistant pathogens
exploit this mechanism
to up-regulate antibiotic
resistance genes, and so
survive even in the presence
of antibiotics. In effect, the
delay allows the bacterium
to prepare a defense against
the antibiotic.
Yap found that the azithromycin-bound ribosomes
do not stall at random residues, but only at specific sites.
Intriguingly, these residues
seem to be the preferred sites
in the “ribosome stalling”
that alters genetic activity.
“Here we describe, to
our knowledge, the first
genome-wide snapshot
of ribosome distribution
along messenger RNAs
in Staphylococcus aureus,”
said Yap, whose work was
funded through a $180,000
grant from the Mallinckrodt
Foundation. “By globally
mapping the position of
stalled ribosomes in azith-
romycin-treated staph, we
identified a specific subset
of proteins affected by this
antibiotic. Yap hopes this
new understanding of this
type of antibiotic resistance
will offer opportunities to
improve drug effectiveness
and give doctors more tools
to help patients with severe
infections.
Di Cera Named
Fellow
Enrico Di
Cera, M.D.,
the Alice
A. Doisy
professor and
chair of the
department of
DI CERA
biochemistry
and molecular biology, has
been named a fellow of
the Academy of Science
of St. Louis. The academy
honored Di Cera for his
work with the blood-clotting
protein thrombin, which
shows promise for future
treatments for thrombosis
and stroke.
Di Cera’s achievements
span basic contributions to
the theory of ligand binding
to defining new anticoagulant strategies with engineered thrombin variants.
He has published hundreds
of scholarly papers and
reviews about the topic.
Read about recently
published research from Di
Cera in which he crystallizes
the key coagulation factor
prothrombin — a feat that
has eluded scientists for
four decades: www.slu.edu/
x95631.xml.
Endowed Professorship in
Plastic Surgery Will Boost Research
A generous gift from Dr. Vasu and Lisa Pandrangi will
allow Saint Louis University to invest in plastic surgery
research. The $500,000 gift will fund an endowed professorship to promote the translation of clinical and basic
research to patient care through research in the division of
plastic and reconstructive surgery.
In March, director of plastic and reconstructive surgery
Bruce Kraemer, M.D., was invested as the inaugural holder
of the Lisa and Vasu Pandrangi, M.D., and Family Professorship in Plastic Surgery.
Pandrangi is chairman of the board of Southwest
General Health System in Middleburg Heights, Ohio; a
member of the board of trustees of University Hospitals
in Cleveland; and chief of plastic surgery at Southwest
General Health Center and St. John Medical Center in
Cleveland. After completing his medial education in India,
and training in England and the United States, Pandrangi
completed specialized training in plastic surgery at Saint
Louis University under the mentorship of then-director of
plastic surgery, F.X. Paletta, M.D.
“I am grateful for receiving my training in plastic surgery
at Saint Louis University,” Pandrangi said. “The training
was broad and had enormous depth pertaining to clinical
learning. Dr. F.X. Paletta was a very colorful individual and
a great mentor.”
While in training, Pandrangi recalls working at hospitals
across the city, including St. Louis City Hospital, VA Medical Center, Cardinal Glennon Children’s Medical Center,
4 GrandRounds
Lisa and Vasu Pandrangi, M.D. with Bruce Kraemer, M.D., inaugural holder of a
professorship established by the Pandrangi family.
Firmin Desloge Hospital and St. Mary’s Health Center.
During his time in the city, Pandrangi met, Lisa,
his wife of 30 years. She is a registered nurse and
office manager for their practice in Westlake, Ohio.
The Pandrangis have four children.
Kraemer, a SLUCare Physician Group plastic surgeon,
specializes in adult plastic and reconstructive surgery,
wound care and hand surgical care. With an interest in
regenerative medicine research, he applies the latest
techniques in his practice, including the use of extracellular
products to constructively remodel wounds and promote
the healing of non-healing wounds.
The Pandrangis feel strongly about the value
of giving back to the community.
“I am hoping that the discoveries made through the
research funded with this endowment will help the human
condition in a broad and scalable way. I am profoundly
honored to have this opportunity,” he said.
Generous Gift Helps the School of Medicine
Address the Primary Care Shortage
mary care physicians are the front line,
first contact that most people have to
any patient care, and their outreach is
key to how well a community fares.”
The Everest Foundation is a
non-profit research organization
of professionals from all arenas of
medicine that supports graduate medical education programs at medical
schools and hospitals. It implements
Fred P. Pestello, Ph.D., president of Saint Louis University, Bimla Everest,
graduate medical education programs
widow of Edwin Everest, M.D., Greg Heffernan, Ph.D., director of foundation
relations for the Everest Foundation and Michael Higgins, executive director and long-term research endowments
of Medical Center Development.
that create innovative infrastructures
and initiatives to transform health
A $6.6 million gift from the Everest Founcare
in
medically
underserved areas, including
dation to Saint Louis University will enhance
the
developing
world. It
is particularly comtraining and educational opportunities for
mitted
to
increasing
the
number
of family
primary care physicians, ultimately bringing
medicine
and
internal
medicine
physicians
in
care to patients in underserved areas.
the
United
States.
“We are grateful to the Everest Foundation
“Our cities and rural areas cry out for
for providing SLU with additional resources
more
physicians to give patients the attention
to improve health care for patients from comthey
need
— not only technically superb care
munities in need,” said Fred P. Pestello, Ph.D.,
that
a
sub,
sub-specialist provides, but personpresident of Saint Louis University.
al,
compassionate
and insightful care that a
“We appreciate that such a prestigious orfamily
medicine
physician
or general internist
ganization recognizes the excellence of what
brings
to
the
practice
of
medicine,”
said Philip
we do, and we know that their generous gift
Alderson,
M.D.,
dean
of
SLU
School
of Medwill allow our SLU School of Medicine to exicine
and
vice
president
for
medical
affairs.
pand our efforts to prepare future physicians
“This generous gift from the Everest Foundato care for each patient with compassion and
tion presents us with an opportunity to train
skill as they address the most pressing health
even more physicians in the disciplines that
care challenges of today.”
most closely resonate with this idea.”
The Everest Foundation sought a partnerThe Everest Foundation is funding the
ship with SLU, said Greg Heffernan, Ph.D.,
Saint
Louis University primary care initiative
director of foundation relations for Everest
for
the
next 10 years. The gift will allow Saint
Foundation, and the product of Jesuit secondLouis
University
to:
ary and higher education.
A
dd
five
new
primary care residency
“I contacted Saint Louis University School
positions
—
two
three-year residents
of Medicine, a very respected Jesuit university
in
family
medicine
and three one-year
in the midst of America’s heartland, as a way
preliminary
internal
medicine residents.
of bridging my own education experience
E
stablish
a
research
fellowship in family
under the Jesuits and translating that into our
medicine
that
grants
a Master of Public
foundation mission in health care. I discovHealth
or
Master
of
Science
in public
ered in SLU an institution that is engaged in
health
degree
after
completing
a family
impressive research and deeply committed to
medicine
residency.
caring for and teaching the next generation
C
reate a visiting fellowship program
of physicians to assist underserved patients,”
that
may include clinical and/or research
Heffernan said.
training
mentored by faculty.
“The Everest Foundation is working on
In
February,
during a ceremony to recogvarious initiatives to encourage doctors to
nize
the
gift,
SLU
named the Health Science
practice in urban and rural underserved areas,
Education
Union,
located in the heart of the
and we particularly are aware of the challenges
Medical
Center,
the
Edwin Everest Educaof not having enough primary care physicians
tion
Union.
in underserved regions,” he continued. “Pri-
THE DETAILS
While adding residents most
directly addresses the shortage
of primary care providers, the
other initiatives made possible
by the Everest Foundation gift
enhance research and clinical
skills of physicians, which ultimately strengthens the practice
of medicine.
RESIDENCIES
The only urban family medicine
residency program in St. Louis,
SLU’s three-year program trains
12 residents to practice family
medicine in an urban, underser ved setting. The gift will
expand the program to teach
two more residents annually,
which means the family medicine program ultimately will
grow to educate 18 residents.
The Everest Foundation also will
add three preliminary (one-year)
internal medicine residents.
FAMILY MEDICINE RESE ARCH
FELLOWSHIP
SLU will create a family
medicine research fellowship
program — a post-residency,
fourth year of intensive clinical
and public health education —
for family physicians. Under
the mentorship of a family and
community medicine faculty
member, the fellow will earn
a Master of Public Health
or Master of Science
in public health at SLU’s
College for Public Health
and Social Justice, as well
as care for patients at
affiliated practice sites.
VISITING RESE ARCH FELLOWS
Graduates of medical and
osteopathic schools and
international medical programs
who are not enrolled in a
residency program will have
the opportunity to gain clinical
experience and/or conduct
medical research for between
six and 12 months at SLU.
Saint Louis University School of Medicine 5
VIRAL INFECTION
SYMPTOM VACCINE
IVER DISEASE
VIRUS
TRANSFUSION
TOXINS
FIBROSIS
TATT
AUTOIMMUNE
TRANSFUSION
MEDICINE
ORGAN
CONTAGIOUS CIRRHOSIS JAUNDICE
TRANSFUSION VIRUS
BLOOD TRANSFUSION
MEDICINE
DISEASE
PIERCING
BLOOD TEST
TOXINS JAUNDICE CIRRHOSIS
HCV
ALCOHOL
FATTY LIVER BLOOD TEST
SEXUAL CONTACT DEATH PIERCING
LIVER DAMAGE AUTOIMMUNE LIVER
CONTAGIOUS
HBV
HAV
DEATH
HCV
HEPATITIS MEDICAL CONDITION
CONTAGIOUS VIRAL INFECTION
LIVER
TRANSFUSION
CIRRHOSIS
HAV
CAUSE
HEALTH
BLOOD TEST
AUTOIMMUNE
ATH
TRANSPLANT
MEDICAL CONDITION HAV
ORGAN
ATITIS
TOXINS
FIBROSIS
SEXUAL CONTACT
INFLAMMATION
AUTOIMMUNE
TIS CIRRHOSIS INFLAMMATION
TRANSFUSION
ORGAN
NE HCV
PIERCING
LIVER
HBV
TATTOO
FIBROSIS
DEATH
JAUNDICE
VIRUS
ITION SYMPTOM
DEATH
LIVER
DAMAGE
VACCINE
VIRAL INFECTION
HEALTH
BLOOD
TOXINS
DICINE HAV
BLOOD
LIVER
FATTY LIVER
VIRUS
VACCINE
HBV
PIERCI
FATTY LIVER
DISEAS
VIRUS
CONTAGIOUS
CIRRHOSIS
BLOOD TE
DI
ALCOH
INFLA
HBV
HEPATITIS
BLOOD TEST
DEATH
TATTOO
VACCINE
ORGAN
SYMPTOM
VIRAL INFECTION
HEALTH
WELL EARNED
REPUTATION
SCHOOL OF MEDICINE SPECIALISTS ARE AT THE FOREFRONT
OF RESEARCH AND CLINICAL MANAGEMENT OF
DEVASTATING LIVER DISEASES
S
Some of the highest-profile physicians and
researchers in the nation staff the Saint
Louis University Liver Center. Specialists
from the division of gastroenterology and
hepatology see more than 700 patients a
month with various liver diseases.
Supported by a cross section of faculty
from multiple clinical and academic
divisions, the center also is a leader in
NIH-funded clinical and laboratory based
liver disease research. The center has
more than 40 clinical trials underway at
any given time.
In this issue of Grand Rounds we focus
on just a few of the center’s strengths in
patient care and research: abdominal
transplantation, fatty liver disease
and hepatitis C.
Bruce R. Bacon, M.D. and Marsha Hensley
6 GrandRounds
Saint Louis University School of Medicine 7
GET TING WE AK ER
Although she was napping constantly after her hospital
discharge, Hensley remained fatigued. She felt sick to her
stomach and couldn’t tolerate much beyond chicken noodle
soup and broth. She was retaining fluids. She was too weak to
return to her job as a pediatric nurse at Shriners Hospital, and
she could barely take care of her children. Her parents moved
in for a while to help.
“I was homebound,” Hensley said. “I felt completely
worthless.” Finally, after three years of undergoing inconclusive tests at
other medical institutions and feeling as though she were living
in a fog, Hensley was referred to Bruce R. Bacon, M.D., professor of internal medicine, executive director of the Center
for Abdominal Transplant and co-director of the Saint Louis
Hensley’s transplant follow-up requires monthly blood work.
best outcome data in 20 years.
The center’s strength is bone deep according to director
Janet E. “Betsy” Tuttle-Newhall, M.D., professor of surgery
and co-director of the Center for Abdominal Transplantation.
During the past five years, she and her team have reworked the
transplant program’s policies and procedures to allow more
patients access to life-saving organ transplants.
The revamp started with establishment of a multi-disciplinary, state-of-the-art clinic on the third floor of the Doctors
Office Building, where liver, kidney and pancreas transplant
patients can see their hepatologists, gastroenterologists,
nephrologists, transplant surgeons and nurses in the same location and often on the same day, rather than making separate
appointments.
Since the new clinic opened, patient visits have grown
nearly 30 percent, with nurses and physicians seeing approximately 16,000 patients a year. The coordination of care also
has shaved 7 percent from the time patients wait between
their initial visits to placement on the transplant list. Once
on the list, the average wait for a kidney transplant is about
three years. The wait is about a year for a liver. Most kidney
transplant patients travel from a 100-mile radius of St. Louis.
Liver transplant patients travel from longer distances, often
up to 500-miles.
COMING TOGETHER
Landon V. Ware, M.B.A., transplant administrator, said they
have further strengthened continuity of patient care by tearing
down the silos between faculty and staff in the hospital and
School of Medicine. Transplant team members, once spread
8 GrandRounds
across campus and on
various floors of Saint Louis
University Hospital, now are
on one floor. The center’s
MY JOURNEY HAS
process improvement goals
BEEN INCREDIBLE.
are written in marker on the
THE TRANSPLANT
wall for all to see. If a goal
TEAM AT SLU HAS
is identified, it’s written on
BEEN THERE EVERY
a wall. If a goal is achieved,
it’s celebrated on the wall. If
STEP OF THE WAY
staff or faculty have an issue
– MARSHA HENSLEY
that needs to be discussed at
the clinical team’s quarterly
retreat, it goes on the wall.
“The wall is about transparency and team building, which
ultimately benefits our patients,” Ware said.
The center’s team has grown by 12 percent in the last few
years with the addition of support staff, post-transplant nurses
and, most recently, nationally known transplant surgeon,
Henry B. Randall, M.D., an associate professor of surgery who
specializes in highly complex transplant surgeries and is former
director of abdominal transplantation, hepatobiliary and pancreatic surgery at St. Luke’s Hospital in Kansas City.
The center also hired two outreach coordinators dedicated
to engaging with referring physicians and patients in a continually expanding catchment area. The coordinators travel beyond
Missouri’s borders to north central Illinois and parts of Indiana
and Kentucky to inform physicians and patients about the
transplant process, the benefits of dual listing (registering at
two or more transplant centers), the advantages of live donation and the rights of donors and potential donors. In addition,
the center is reaching out to physicians through continuing
medical education opportunities and webinar series.
“
“
University Liver Center. Bacon performed
a liver biopsy that revealed Hensley had cirMARSHA HENSLEY’S STORY STARTED
rhosis from fatty liver disease. She needed a
WITH A QUARTER INCH ABR ASION
liver transplant and soon.
TO HER RIGHT INDE X FINGER. “Liver disease never crossed my mind,”
She was trimming bushes in front of her
she said. “I was overwhelmed by the idea
Wildwood home in St. Louis County,
of a transplant, but I was starting to have
cleaning up before the family left the next
seizures due to an electrolyte imbalance, so
morning for vacation at the lake. Within a
I was open to anything at this point.
few hours, the cut she sustained in her yard
“Every three days they’d run labs to
turned red and her finger was swelling —
determine what my values were, and I’d
then another finger and another.
wonder whether the results were going to
Hensley wasn’t sure she could drive.
push me up or down on the waiting list. It
Luckily, a friend across the street was able to
was an emotional rollercoaster.”
take her to a nearby emergency room, where
Within a week, Hensley’s liver was so
doctors informed Hensley that necrotizJanet E. “Betsy” Tuttle-Newhall, M.D.
compromised she moved to the top of the
ing fasciitis was eating its way through her
list. Nine days later she received a call that a match had been
fingers and up her arm. The bacteria quickly crept past each
found. Her parents, who lived nearly two hours away, beat
line the doctors drew to monitor the progression. Doctors
Hensley to the hospital.
opened Hensley’s fingers and arms and cleaned out as much of
the bacteria as they could. Hensley was intubated and placed
STRE AMLINED CARE
in a drug-induced coma for several days as strong antibiotics
Hensley said she went into her 2009 surgery nervous but
coursed through her body to fight the infection. Hensley, who
with strong faith in her transplant team and for good reason.
prior to this incident was a healthy mother of two who rarely
The Abdominal Transplantation Center at Saint Louis
went to the doctor, was in the hospital nearly a month before
University Hospital meets or exceeds outcome standards
doctors sent her home to finish recovering — but she never
set by the Scientific Registry of Transplant Recipients —
quite did. Unbeknownst to Hensley, a disease unrelated to her
the organization that sets the bar by which all transplant
infection had begun destroying her liver.
programs are measured. The center currently is reporting its
A TRANSPLANT
TR ANSPL ANT TR ACKING
During the past four years, the transplant center has seen a
78 percent increase in kidney referrals, a 117 percent increase
in living donor kidney referrals, and the kidney transplant
wait list has grown by 35 percent. Liver transplant referrals
have increased by 103 percent, and the wait list for liver
transplantation has grown by 15 percent.
To accommodate the increasing numbers of patients and
ensure their quality of care, the center installed a nearly $1
million information technology program that tracks patients as
they move through the transplantation process — from initial
referral, to financial clearance, to wait listing, to transplantation,
to follow-up visits.
“The program allowed us to take systems that were once
perpendicular and make them parallel,” said Tom Allen, the
transplant center’s business manager. “Rather than waiting for one team member to complete his or her piece of
the treatment plan, team members, such as social workers,
dieticians and nurses, can work on the same patient simultaneously because they can see where the patient is in the
system at any given time. If there’s a slowdown, we can
identify it and fix it. This saves patients hours, even days off
wait times.”
The department’s goals and achievements are written on the office walls for all to see.
RESE ARCH WITHIN RE ACH
The transplant center also redesigned its website to support
patients through the transplantation process. The site contains
team profiles, news about abdominal transplantation and an
active blog (slutransplant.com/news-blog/) with the latest in
transplant research, including the groundbreaking translational
research by School of Medicine scientists and clinicians.
The blog is kept current by Krista L. Lentine, M.D.,
Ph.D., M.Sc., professor of internal medicine in nephrology
and medical director of living donor kidney transplantation
for the center.
Lentine said the center’s commitment to excellence integrates its patient-centered care with a robust clinic research
program, as well as participation in the professional societies
that actively shape transplant policy. For example, the center’s
current NIH-funded research agenda includes projects examining long-term health outcomes of living kidney donors and
the balance in efficacy and morbidity associated with transplant
immunosuppression regimens. Transplant faculty members
serve as representatives on committees of the United Network
for Organ Sharing, the American Society of Transplantation
and Kidney Disease Improving Global Outcomes.
“The blog gives me the opportunity to share updates on
emerging research findings, discuss evolving policies and
clinical practice guidelines and highlight key controversies in
our field,” she said. “It’s a way to provide regular snapshots of
timely, important events at our center and in our field, and we
actively welcome feedback.” Within the next year, the transplant team hopes to add live chats to the website.
THE ROAD BACK
Marsha Hensley’s liver transplant surgery was successful. She
spent a couple of years catching up on the time she lost with
her children and volunteering at Mid-America Transplant
Services, which coordinates the procurement of vital
organs, tissues and corneas in hospitals throughout eastern
and southern Missouri, southern Illinois and northeastern
Arkansas. She went from volunteer to staff two years ago when
Mid-America hired her as a nurse in its quality review division
that ensures tissues and corneas are suitable for transplant.
“My journey has been incredible,” said Hensley, who
continues to submit to monthly lab tests. “The transplant
team at SLU has been there every step of the way.”
Saint Louis University School of Medicine 9
A CURE FOR
HEPATITIS C
B
AFTER NEARLY 30 YEARS OF PRESCRIBING
MEDICATIONS THAT CURED HEPATITIS C IN FEWER THAN
HALF OF HIS PATIENTS, BRUCE R. BACON, M.D., NOW
PRESCRIBES TREATMENTS WITH CURE RATES BETTER
THAN 90 PERCENT.
ruce R. Bacon, M.D.,
has been searching for
improved treatments since
1989 when scientists discovered
the hepatitis C virus. Bacon
and fellow researchers in the
Saint Louis University Liver
Center have led the nation in
enrollment in several pivotal,
multi-center clinical trials, and
recent trials have resulted in three
breakthrough treatment regimens.
Between 2013 and 2014, the
Food and Drug Administration
(FDA) approved three treatment
protocols with 90 percent or
better cure rates.
The FDA has approved
Bruce R. Bacon, M.D and Adrian M. Di Bisceglie, M.D.
a combination of two oral
antivirals — Olysio and Sovaldi
— that offer a cure rate of 90
Di Bisceglie said some patients have less than optimal replus percent; Harvoni, a once-daily single tablet with a 95-plus
sponses to the new regimens, including patients with advanced
percent cure rate; and VieKira Pak, a combination of three
liver disease and those infected with the genotype 3 strain of
oral antivirals with a 95-plus percent cure rate.
hepatitis C. He said SLU researchers continue to work to optiBacon’s colleague, Adrian M. Di Bisceglie, M.D., chairman
mize treatment for these individuals.
of the department of internal medicine, co-director of the
Some of the attention on the new hepatitis C medicaliver center and an internationally recognized expert in viral
tions has focused on pricing. Sovaldi, for example, initially
hepatitis and liver disease, also noted that SLU researchers
costs approximately $1,000 a pill, and the treatment regimen
wrote or co-wrote major published papers describing results
requires 84 pills over a 12-week period. Bacon said this seems
from the clinical trials. In addition, he said School of Medicine
like a hefty price tag until you compare it to the interferphysicians have served as consultants to pharmaceutical comon-based treatment. Patients had to be on the telaprevir or
panies developing the new drugs.
boceprevir for 12 weeks, followed by an interferon-based
“It’s been extremely gratifying to watch the rapid progress
regimen for an additional 12 to 36 weeks — the average cost
of medical discovery and to feel that we’ve played a role
of which was similar to the current costs. Bacon also noted
in transformational events that will save many lives,”
that pharmaceutical companies are offering discounts on
Di Bisceglie said.
the breakthrough medications, and treatment is becoming
Bacon said the drugs demonstrate substantial improveavailable to more patients.
ment over the previous regimens that included the protease
The Saint Louis University Liver Center has
inhibitors, telaprevir and boceprevir, along with
one of the most robust hepatitis C treatment
ribavirin and peginterferon. The regimens had
programs in the world, and physicians anticside effects so intolerable that many patients
ipate treating hundreds of patients this year
discontinued treatment. The newer medicawith the new medications.
tions have virtually no side effects. They also
“To go from discovery of a virus to a cure
demonstrated efficacy in patients who could
in 95 percent of patients is an amazing thing
not tolerate the interferon-based treatment
to happen during the course of one’s career,”
regimens, patients awaiting liver transplantation
Bacon said. “Dr. Di Bisceglie and I feel very
Hepatitis C medication.
and HIV co-infected patients.
blessed to have been a part of it.”
10 GrandRounds
A BREAKTHROUGH WITH NASH
F
atty liver disease — or nonalcoholic steatohepatitis
(NASH) — continues to afflict a growing number of
adults and children, and it faces a fierce opponent in
Brent Neuschwander-Tetri, M.D., director of the division
of gastroenterology and hepatology
Since joining the SLU medical faculty in 1991, Tetri has
been leading research initiatives to advance potential therapies
for the disease, which is estimated to afflict at least 5 percent of
the population and has no approved medications for treating it.
In 2002, Tetri became a founding member of the NASH
Clinical Research Network, a group of principal investigators
from eight clinical centers across the United States. Supported
by the NIH, the group conducts research trials to better
understand why individuals develop NASH and to help
discover effective treatments.
SLU also is conducting numerous large-scale NASH clinical
trials, including the FLINT trial — a recent study led by Tetri
and published in The Lancet — that revealed promising results of
an experimental drug called obeticholic acid. The drug helped
improve liver function in nearly half of the NASH patients who
used it. Previous research with vitamin E and the diabetes medication pioglitazone has generated positive results as well.
SLU also is conducting early-stage research into promising
drug candidates using animal models. In one study, recently
published in the journal Molecular Metabolism, SLU researchers
fed mice a special high trans-fat, high fructose diet designed by
Tetri to mimic the liver disease that people develop. Then these
mice were treated with SR9238, a liver-specific LXR inverse
agonist that reduces the liver’s ability to produce fat. The drug,
developed by a team in the School of Medicine’s pharmacological and physiological science department, now will progress to
clinical trials to determine its safety and effectiveness in people.
“Our hope is that we can develop an effective treatment for
fatty liver disease that will prevent ongoing damage to the liver
and allow scar tissue to gradually recede, even if someone has
already developed cirrhosis,” Tetri said.
Beyond his focus on research, Tetri is also on an educational
mission to convince the medical community to take NASH
more seriously. His efforts include educating primary care
providers, endocrinologists and even school nurses about risk
factors, including obesity, diabetes, hypertension and elevated
blood lipids. He also advocates for the importance of urging
NASH patients to modify their lifestyles through healthier
eating habits, increased levels of exercise and weight loss so
they can effectively manage the disease.
“It’s common for us to see folks who have already
progressed to cirrhosis that have been told by their primary
care doctor not to worry about it,” Tetri said. “But they should
be worried about it, because NASH is now the third most
common reason for liver transplantation and a substantial risk
factor for death from end-stage liver disease.”
As with any form of liver disease, the goal is to more
fully understand the causes of NASH so researchers can
rationally design effective therapies beyond the existing
lifestyle treatments.
“We don’t just want to throw drugs at a disease that can
be effectively treated with lifestyle modification,” Tetri said.
“But because it is very challenging for most people to achieve
weight loss, it would be very helpful to have a medication that
prevented or reversed fatty liver disease in adults and children
to prevent ongoing damage to the liver. One of the things that
will ultimately change the perception of NASH is when we
develop effective therapies for the disease. Then people will
really open their eyes to it.”
PHVO = partially hydrogenated vegetable oil (a source of trans-fat). The percent is the amount of fat in the mouse chow by weight.
Liver cancer in
mice fed a high
transfat diet
for 1.5 years.
Neuschwander-Tetri,
manuscript in preparation.
PHVO 0%
L ARD 0%
0 /18
PHVO 0%
L ARD 22%
PHVO 1.1%
L ARD 20.5%
PHVO 5.5%
L ARD 16.5%
2 /10
1/13
5/15
PHVO 22%
L ARD 0%
14/20
0% 20% 40% 60% 80%100%
PERCENT WITH VISIBLE TUMORS
Saint Louis University School of Medicine 11
SNAPSHOT
Mary T. McLennan, M.D.,
F.A.C.O.G.
BIRTHPL ACE :
Mackay, Queensland, Australia
MEDICAL DEGREE
University of Queensland Queensland, Australia
LE ADERSHIP ST YLE
I lead by example. I would never ask
my faculty to do anything I’m not
willing to do or haven’t done. It’s also
not my style to tell people what needs
to be done, though there are times
when that may be needed. It is my
preference to sit down and figure out
what’s the best for them and best for
the department. It’s a shared model
of leadership. I think that’s the only
way to engage people.
E XPERIENCE
MARY T. MCLENNAN
NEW CHAIR OF THE DEPARTMENT OF OBSTETRICS,
GYNECOLOGY AND WOMEN’S HEALTH
When Mary T. McLennan, M.B.B.S., F.A.C.O.G., was an obstetrics and gynecology resident
at Saint Louis University School of Medicine in the early 1990s, the department had four
faculty members and two additional affiliates at Deaconess Hospital. The department she
now chairs has grown a bit since then.
“We have 30 physicians, two nurse practitioners and two midwives, and offer care in not
only general obstetrics and gynecology but also every sub-specialty in the field,” she said.
“The department is an incredibly vibrant and large organization that I’m honored to lead.”
McLennan, a nationally known urogynecologist, was appointed chair in March after serving
as vice chair of the department for two years and then interim chair since July 2014 when
Raul Artal, M.D., retired. In this article, McLennan shares her leadership vision.
MOTIVATION
Honestly, I never imagined I’d be chair.
Chairing the department was not a career
path that I had planned. I wanted to be a
clinician and educator. Dr. Artal suggested
I consider the position, and after thinking
on it and talking to faculty, six weeks later I
decided to apply. I knew being chair would
require a lot of hours, and the job would
mean cutting back on my time with patients
and residents — two of the things I love
most about my work — so it was a conflict.
But then I started thinking about the unique
relationship we have with SSM St. Mary’s
Health Center. It’s a different relationship
than most university departments have
with a hospital, and not just here at SLU
but across the country. We are inextricably
linked. It’s a productive, healthy relationship.
I realized it would break my heart to have
someone come into the department who
didn’t appreciate and nurture that relationship. Both of our units are successful because of the relationship that has been built.
I decided I’d pursue the position because I
had a great understanding and respect for
the relationship. There is a saying: “If you’re
not at the table, you might be the lunch.”
SHARED VISION
We have an amazing cadre of people in this
department who are committed to providing patient-centered care. Ten years is the
average length of time faculty members
have been with the department. That speaks
to our stability. Faculty and staff get along
incredibly well, and we have a shared vision.
I don’t want our department to be stagnant,
but what we have works, and it works very
well. I’m fortunate the department was left
in such a wonderful position by Dr. Artal.
Private Practice
Family Medical Center
Queensland, Australia
Resident
OB-GYN
Saint Louis University
at St. Mary’s
Fellow and
Urogynecologist
Greater Baltimore
Medical Center
Faculty
OB-GYN
Saint Louis University
1999 - Present
Residency
Program Director
2007 - Present
Professor
2009 - Present
Vice Chair
2013 - 2015
CLINICAL INTERESTS
Urinary and fecal incontinence
Pelvic floor disorders
Pelvic reconstructive surgery
RESE ARCH INTERESTS
Incontinence
Tension free slings
Role of hydrodistension
and interstitial cystitis
Role of estrogen
in interstitial cystitis
HONORS
CREOG Service
Recognition Award
APGO Excellence
in Teaching Award
Best Doctors in America
WHAT MAT TERS MOST
We’re not focused on a disease.
We’re focused on the patient. It’s
about Mrs. X who may have two kids,
one she’s struggling with, or has an
elderly parent who just moved in. We
know our patients because we get involved. I couldn’t work here if all I did
was a quick visit and a medication refill.
I’m engaged in my patients’ lives. It’s
one of my strengths and makes work
fulfilling and enjoyable.
BR AGGING RIGHTS
We’re well known for our high-risk
obstetrics, but we also offer comprehensive gynecological services in every
sub-specialty. That is less well known.
I hope to change that. I want patients
and physicians to know we have the
largest urogynecological practice in
the area. We have the only center for
endometriosis and the only division
of minimally invasive gynecologic
surgery. We also have the only vulvar
and vaginal disorders center; offer a
Catholic approach to infertility; and
have patient-focused gynecological
cancer care. With the addition of SLU
breast cancer specialists establishing
services at St. Mary’s, we will be able
to coordinate female cancer care for
our patients. Also, in collaboration
with SSM Cardinal Glennon Children’s
Medical Center, the department has the
Fetal Care Institute. It’s the only center
in the state to offer open and minimally invasive fetal surgery to babies in
utero. It’s the second largest center in
the country. We know what resources
and amazing care we provide, but we
need to do a much better job of letting
others know as well.
FUTURE VISION
RESIDENCY TR AINING
Sometime in 2016 we hope to establish
a multispecialty, multidisciplinary pelvic
pain and continence center in partnership with SSM. Rather than sending
patients to multiple facilities, we want
to establish a Women’s Center that will
provide patients everything at one site
— pelvic pain services, urogynecology,
gastroenterology, physical therapy, psychological services, sexual counseling.
Some of the conditions we treat can
be hard on personal relationships and
are difficult to talk about, but if care
is coordinated, the patient only has to
tell her story once. It’s all about making
things easier for the patient. No other
institution offers this level of care. We
also plan to increase our maternal fetal
medicine services in the region.
My residency at SLU was the best time
of my professional life. I absolutely
loved it, and being able to direct the
residency training program for the last
eight years, to offer residents the same
rich experience that I had, was another reason I returned to SLU in 1999.
Residents keep you on your toes. They
challenge you. They stimulate you. The
old saying is true: “If you treat a patient you help one person. If you teach
a resident you’re helping thousands.”
I love being in an operating room with
a resident who doesn’t know how to
do something. Then you teach them
and see them progress to the point
where you can say, “It’s all yours.
You can do this on your own.” At an
educational conference recently I saw
a resident who graduated from our
department seven years ago and is
currently on the faculty at Washington
University, where she’s developing a
vaginal surgery training model for
residents. She said whenever she gets
into a difficult spot in the operating
room during a vaginal surgery case she
stops and asks herself, “What would
McLennan do?” That’s rewarding.
CAREER PATH
My career took a circuitous pathway. I
was a family practice physician in rural
Australia, where I treated mostly women
and children, and I really enjoyed it.
We performed obstetrics but not Gyn
services. So when I moved to the United
States I decided I wanted to do obstetrics and gynecology, so I came to SLU
for a residency in the early ’90s. During
my third year, I started to operate and
realized that we were performing the
same surgery for different conditions.
Women who had incontinence were
having the same surgery as women with
prolapse. It didn’t make sense to me, so
I started doing a lot of reading and had
a wonderful mentor who encouraged me
to pursue urogynecology. It was then I
changed from general obstetrics/gynecology to urogynecology.
COMMIT TED TO SLU
After my residency experience, I completed a fellowship in Baltimore and was
on the faculty at the Greater Baltimore
Medical Center. But I knew I wanted to
return to SLU. It was the mission and
the wonderful people. I feel we live the
mission every day — “Higher purpose.
Greater good.” It’s not just lip service.
It’s how we treat our patients and how
we treat one another. SSM has the
similar mission. We never turn anybody
away. Whether they have Medicaid or
private insurance or no insurance at all,
we give all of our patients the same care.
COMMUNIT Y SERVICE
We’re in the community like no other
department at SLU. We operate ObGyn
clinics at three public health clinics in
St. Louis (John C. Murphy Health
Center, South County Health Center
and North County Health Center).
Our faculty and residents provide care
there three full days a week. The patient
volume has increased about 36 percent
at the clinics in the last year because
patients know they’re getting quality
care and continuity of care.
AT HOME
I have a wonderful, supportive husband
(an ER physician in rural Missouri) and
a non-traditional family. We have no kids
but we have six rescue dogs. We’re a pug
family. We have five pugs and a “mug”
(the one non-pug we found on the side
of the road about six months ago). We
love our dogs. Antiquing and traveling
are our other passions.
Press Ganey Provider Star
12 GrandRounds
Saint Louis University School of Medicine 13
Michael T. Railey, M.D.
A WIDE
LENS
health problems in underserved populations.
E ARLY E XPOSURE
CULTURAL COMPETENCY
TRAINING IN CLASS AND
IN THE COMMUNITY
Twenty-eight first- and second-year
medical students gather over a lunch
of sweet and sour chicken, steamed
vegetables, sticky rice and a hot topic:
the school-to-prison pipeline. The
pipeline theory purports that school
suspensions and expulsions are
pushing children out of public schools
and into the juvenile justice system.
Many of these children have learning
disabilities and histories of poverty,
abuse and neglect.
The medical students watch a brief
video exploring the epidemic, and the
screen fills with statistics demonstrating
that zero-tolerance policies in schools
appear to disproportionately target
students of color. The medical students
break into small groups.
One student questions how students can feel welcome when the first
thing they see when they walk through
the door is a metal detector. Another
student says the security presence and
zero tolerance policies are necessary to
keep schools safe for other students. A
second-year student who was suspended
more than a few times in high school
says the more time he spent out of class
the farther behind he fell and the harder
it became to catch up or care.
After about an hour the discussion
winds down, and students head to class.
“The intent is
not to solve the
problem of health
or socioeconomic
disparity in the
United States,”
said Dylan
Hanami, a second-year medical
student from Los
Hanami
Angeles. She and
14 GrandRounds
systems; beliefs about how diseases are
caused; compliance with care; and attitudes toward health care providers.
other first- and second-year students
have been organizing these weekly
discussions on race, bias and socioeconomic disparities since fall 2014. “The
problems are outgrowths of historical
discriminatory practices. We’re trying
to break down walls and have conversations about things that may make us
uncomfortable.
“To most people, these topics might
not seem directly related to medicine,
but they are intimately intertwined,”
she said. “You can’t be a compassionate
doctor without first being a compassionate person. That requires having
an open mind and trying to understand
someone’s story because their story has
an impact on their health.”
ALL IN THE TIMING
The students established the discussion
groups last fall, not long after two grand
juries declined to indict white police
officers in the deaths of unarmed black
men: Michael Brown in Ferguson,
Missouri, and Eric Garner in New York.
To protest the verdicts, students at
more than 50 medical schools, including
Saint Louis University, held “die-ins”
on campus.
Students organized candlelight vigils
and hosted panels on social justice
and community healing. Emotions ran
high, and students felt the time was
right to have a regular forum in which
they could process their feelings in a
non-judgmental environment.
The students went to the medical
school administration, including Michael
T. Railey, M.D., associate dean of multicultural affairs, and Stuart Slavin, M.D.
(’83), M.Ed., associate dean for curriculum and professor of pediatrics, where
they found support.
“The indictments revealed deep
disparities across all lines, whether it’s
policing, safety in neighborhoods, crime,
housing,” Slavin said. “For medical
students I think the decisions raised
awareness of how these disparities could
play out in the health care setting.”
Steven Monda, a first-year medical
student from Ephrata, Washington, and
a discussion group coordinator, said he
thinks the events in Ferguson were jarring to some medical students. He said
talking things through helps clear confusion and relieves some of the frustration
that surrounds issues of disparity.
“Furthermore, as future medical
leaders it’s important for us to become
conscious physicians – conscious of the
opportunities we’ve been given; conscious of the disparities faced by others;
conscious of our own role in alleviating
or perpetuating these disparities,” he
said. “These discussions help me better
understand the complex social situations
I’ll face as a physician.”
Anywhere from a dozen to 30 students participate in the weekly discussions, which have drawn students from
across campus, as well as from Washington University in St. Louis.
PENCHANT FOR SOCIAL JUSTICE
The verdicts also moved into action
School of Medicine faculty, some of
whom participated in the die-in and
sponsor the weekly student discussion
groups. In an editorial printed in the St.
Louis American, Railey, wrote that events
in Ferguson and New York should serve
as reminders to members of the medical
community that they must remain culturally humble, culturally competent and
ever mindful of the societal context in
which they provide care.
“Our students, residents and faculty
must be aware of how health is both
directly and indirectly affected by crime,
violence, proper housing, safety issues,
education and political events,” wrote
Railey, associate professor of family and
community medicine. “Any attitude that
would isolate or separate the intricate
and ongoing process of good health
from socioeconomic and sometimes
political events would be erroneous.”
Railey said the verdicts and protests further reinforce the School of
Medicine’s longstanding commitment
to training future physicians who are
culturally competent and responsive to
the needs of their communities. He said
this commitment begins in the admissions office.
Railey said that members of the
admissions committee make an effort to select students who are smart,
purpose-driven women and men with a
penchant for service and social justice,
such as those who volunteer at the
student-run Health Resource Center,
offer free foot care at homeless shelters,
present information on diabetes care at
local churches and who choose community service electives.
“These students already are beginning to understand that you have to put
your hands to the ground to get a feel
for a community’s vibrations,” he said.
Railey further said that the school
attracts and attempts to select students
predisposed to providing culturally competent care through its M.D./M.P.H program. The program, funded by a grant
from the Health Resources and Services
Administration, trains future physicians
to work with underserved populations.
In addition, the grant supports the
school’s efforts to develop a curriculum
that addresses cultural competency and
management of significant community
Although literature
suggests that providing culturally sensitive
care promotes positive
health outcomes for
patients, not all medical
schools have formal
cultural competency
training curricula.
Railey said this is particularly troubling
because minorities, now roughly a third
of the U.S. population, are expected to
become the majority by 2042.
The American Association of Medical Colleges urges all medical school to
implement a curriculum that provides
for longitudinal exposures to culturally
humble patient care management. It
recommends:
The curricula have the institutional
support of the leadership, faculty
and students.
Institutional and community
resources be committed to the
curriculum.
The institution and its faculty
commit to providing integrated educational interventions appropriate
to the level of the learner.
A cultural competence curriculum
have a clearly defined evaluation
process that includes accountability
and evaluation.
Railey said the medical school curriculum, under the guidance of Slavin,
has been following and, in some areas,
surpassing these guidelines. Rather than
treating cultural competency training as
add-on material that could be de-emphasized or marginalized, the school has
been weaving the training into its curriculum as a formal, longitudinal thread for
nearly a decade.
First- and second-year students are
exposed to cultural competency training
during their Applied Clinical Skills
courses. Slavin, Railey, and other faculty
and selected guests present case studies,
host panel discussions and facilitate
mock interviews that encourage students
to talk about how race and ethnicity
affect: the presentation of symptoms;
health, healing and wellness belief
LOOKING WITHIN
Another critical component of competency training is helping students
recognize their implicit bias. To do
this, Slavin invited Kira Banks, Ph.D., a
professor of psychology in the College
of Arts and Sciences and an expert on
implicit bias, to consult on the school’s
curriculum and to present to students
during their clinical skills courses. Banks
said her mission is to teach students that
they need not only to be sensitive to a
patient’s cultural experiences, they need
to be sensitive to their own.
“We all have biases and prejudices,” she said. “The key is to be aware
of them and keep them in check. If
physicians want to get information from
their patients, if they want their patients
to trust them and comply with their
treatment recommendations, they must
consider how their cultural experiences
and the cultural experiences of their patients come together. This is an important component of clinical care.”
Lessons on implicit bias also are
embedded into lectures for third- and
fourth-year students. Railey’s office
reaches out to graduate students,
residents and faculty through regularly
scheduled events to keep them abreast
of important societal impacts on health.
Although Railey said he is proud of
the school’s commitment to cultural
competency training, he said the school’s
programs must evolve and expand.
Railey said the curriculum management
committees and other efforts work to
bridge the gap between the training students receive during their first two years
and their clinical years.
“We want students to take what
they’ve learned in class across the street
with them to the hospital,” Railey said.
Railey also said he is working on
means to measuring outcomes of cultural competency training.
“What I hope to find is that we’re
graduating students who recognize they
are becoming part of the privileged class,
and they must never turn their back on
those less fortunate,” he said.
Saint Louis University School of Medicine 15
MATCHDAY
171 students
successfully
matched with
a broad spectrum
of high quality
programs
through the
country during
Match Day 2015.
You can help our recent graduates transition into
their residencies through the SLU Medical Alumni
Mentor program. The Alumni Office will match
graduates with alumni in the community where
they will be located. Whenever possible, students
will be matched with alumni in the same health
care institution or in the same field of interest.
To become a SLU Medical Alumni Mentor,
e-mail the Alumni Office at [email protected].
Scenes from Match Day 2015 at the Redbird Club in Busch Stadium.
Clarisse Valencia
Kaiser Permanente Fontana-California
Change Ye Wang
University of Toronto
ANESTHESIOLOGY
Michael Bergin
Harbor-UCLA
Medical Center-California
Haesun Han
Einstein/Montefiore
Medical Center-New York
Daniel Lee
Einstein/Montefiore
Medical Center-New York
Jessica Lee
University of Southern California
Cameron Rice
Eric Fredrickson
Summa Health/Northeast Ohio
Medical University
Thomas Gildea
Stanford University
Programs-California
Sara Hadi
SUNY Health Science Center
Brooklyn-New York
Benjamin Kingsley
Christus Spohn
Memorial Hospital-Texas
Brendan McDaniel
Albert Zheng
Jonathan Meyer
Mercy Hospital St. Louis
Andrew Schroeder
University of Missouri
Kansas City Programs
Louisiana State University
School of Medicine-New Orleans
University of Tennessee
College of Medicine-Memphis
William Petry
Logan Traylor
INTERNAL MEDICINE
Sean Migotsky
David Kraus
Nikhita Ananthula
University of Utah
Affiliated Hospitals
John-Vincent Arcilla
University of Cincinnati
Medical Center
Nabila Azad
Barnes-Jewish Hospital
Stony Brook
Teaching Hospitals-New York
Boston University Medical Center
Jessica Bjorklund
Rush University
Medical Center-Illinois
Shannon Devlin
Adam Dhedhi
Duke University
Medical Center-North Carolina
Catherine Duncan
Winthrop University
Hospital-New York
University of Iowa Hospitals
and Clinics
Harbor-UCLA
Medical Center-California
Michelle Hall
University of Missouri
Kansas City Programs
Saint Louis University
School of Medicine
Kevin Kline
Hospitals of the University
of Pennsylvania
Danielle Davis
John Koch
EMERGENCY MEDICINE
Jeffrey Beckett
Saint Louis University
School of Medicine
Jeffrey DeSmidt
Saint Louis University
School of Medicine
16 GrandRounds
Naval Hospital
Christopher Murphy
Banner Good Samaritan
Medical Center-Arizona
Ophelia Langhorne
Maanjot Rathore
Rebecca Ludwig
Sruti Surugucchi
Saint Louis University
School of Medicine
Tanya Sylvester
Vishal Shah
Wright Patterson Medical Center
Kevin Smith
University of Missouri
Kansas City Programs
Mitchell Stotland
Emily Williams
OPHTHALMOLOGY
Clifford Goodrich
Indiana University School of Medicine
Kevin Song
Queen’s University
Saint Louis University
School of Medicine
Cathleen Becker
Saint Louis University
School of Medicine
Sarah Bieser
Children’s Mercy Hospital
University of Missouri-Kansas City
Jennifer Biggs
Victor Liou
Kirsten Borsheim
Andrew Nguyen
Kaye Brathwaite
Sean Grewal
Brian Sun
Loyola University/Hines VA Hospital
Saint Louis University
School of Medicine
Matthew Starr
Kathleen Costello
Ian Hackett
University of Utah
Affiliated Hospitals
Carolyn Hilliard
University of Iowa
Hospitals and Clinics
John Howard
Shaz Iqbal
Kavitha Jacob
University of Illinois
St. Francis Medical Center
Jeffrey Ko
Cedars-Sinai
Medical Center-California
Robert Koch
Banner Good Samaritan
Medical Center-Arizona
Lucy Lin
University of Minnesota
Medical School
Di Ma
Rush University
Medical Center-Illinois
Rhode Island Hospital/Brown
University
Justin Vander Molen
University of North Carolina
Hospitals
Nicholas Vaughn
Medical College of Wisconsin
Affiliated Hospitals
Cecilia Wang
Georgetown University
Hospital-Washington, D.C.
William Wung
University of California
Davis Medical Center
Sudha Yarlagadda
Baylor College of Medicine-Houston
Justin Yu
California Pacific Medical Center
Pei Zhang
Santa Clara Valley
Medical Center-California
NEUROLOGY
Amir Badiei
Beth Israel Deaconess
Medical Center-Massachusetts
ORTHOPAEDIC SURGERY
Robert Avino
University of Chicago
Medical Center-Illinois
Michael Del Core
University of Texas Southwestern
Medical School-Dallas
Haariss Ilyas
Christopher Mathis
University of Michigan
Hospital-Ann Arbor
Colleen Mathis
University of Michigan
Hospital-Ann Arbor
Indiana University School of Medicine
Tufts Medical Center-Massachusetts
Jennifer Buehler
University of Texas
Southwestern Medical School-Dallas
Regina Dalla Riva
Medical College of Wisconsin
Affiliated Hospitals
Denise Do
Case Western/University Hospitals
Case Medical Center-Ohio
Sarah Donigian
Jessica Modock
Stanford University
Programs-California
Children’s Mercy Hospital
University of Missouri-Kansas City
Ege Ozdemir
Saint Louis University
School of Medicine
Arielle Randolph
Kaiser Permanente
Oakland-California
Abhineet Sharma
Medical College of Wisconsin
Affiliated Hospitals
Sarah Smith
PHYSICAL MEDICINE AND REHABILITATION
Alexander D’Angelo
University of Pittsburgh Medical
Education
Brian Kelly
University of Texas
Southwestern Medical School-Dallas
Sean Smith
Barnes-Jewish Hospital
PSYCHIATRY
Mark Colijn
University of Oklahoma College of
Medicine-Oklahoma City
OTOLARYNGOLOGY
Bharat Panuganti
University of San Diego
Medical Center-California
St. Louis Children’s Hospital
Alice Hackett
Rush University
Medical Center-Illinois
Amber Hamilton
Saint Louis University
School of Medicine
Christina Hartje-Dunn
Northwestern-McGaw/Lurie
Pediatrics-Illinois
Ariel Hofman
Phoenix Children’s Hospital
Angela Hoynacki
Indiana University School of Medicine
Jennifer Keller
Saint Louis University
School of Medicine
Arya Namin
University of Texas Southwestern
Medical School-Dallas
Emily Newton
University of North Carolina
Hospitals
Long Nguyen
University of Texas Medical
School-Houston
Alexander Skopec
University Hospitals Columbia-Missouri
Victoria Wang
University of California
Riverside School of Medicine
Brian Wickers
University of Arizona
Affiliated Hospitals
Brain Young
Case Western/University Hospitals
Case Medical Center-Ohio
THORACIC SURGERY
Alexander Brescia
Medical College of Wisconsin
Affiliated Hospitals
Eastern Virginia Medical School
Ohio State University Medical Center
Charles Manchee
Allie Grither
Jonathan Wojcik
Peter Chao
University of Calgary
University of Southern California
San Antonio Uniformed Services
Health Education Consortium
Geisinger Health System-Pennsylvania
Katelin Sisler
Stanford University
Programs-California
Julie Dorfman
Tierney Shannon
Derek Berglund
Srisindu Vellanki
Michael Jernick
Boston University Medical Center
Andrew Murtha
San Antonio Uniformed Services
Health Education Consortium
SURGERY-GENERAL
Grand Rapids Medical Education
Partners-Michigan
Cleveland Clinic Foundation
Melissa Meister
Barnes-Jewish Hospital
Baylor College of Medicine Houston
San Antonio Uniformed Services
Health Education Consortium
University of California
San Francisco/Fresno
Markus Zei
Chelsea Horwood
Ju Suh
Colin Vale
Children’s Mercy Hospital
University of Missouri-Kansas City
University of Florida
College of Medical-Shands Hospital
William Otto
Jennifer Aleshire
University of Tennessee
College of Medicine-Memphis
Mayo Clinic
Rachel Lieberman
PEDIATRICS
Amy Gould
Santa Clara Valley
Medical Center-California
Eric Pepin
St. Louis Children’s Hospital
Medical College of Wisconsin
Affiliates Hospitals
Drexel University College of Medicine
Madeline Ripa
Theodore Kremer
University of Illinois
College of Medicine-Chicago
Clare O’Hare
University of Cincinnati
Medical Center
University of Southern California
Michael Kim
University of Tennessee
College of Medicine-Memphis
University of Utah
Affiliated Hospitals
Brittany Young
Paul Eckerle
Indiana University School of Medicine
Cory Jones
St. Joseph Hospital-Illinois
Kevin Chow
University of Illinois
College of Medicine-Chicago
Jessicah Hard
University of Colorado
School of Medicine-Denver
Medical College of Wisconsin
University of Wisconsin
School of Medicine and Public Health
Alison Kang
Saint Louis University
School of Medicine
University of Nebraska
Medical Center
Zachary Bryan
University of Texas
at Austin Dell Medical School
David Priemer
Barnes-Jewish Hospital
Jane Suh
Mercy Hospital St. Louis
Hospitals of the University
of Pennsylvania
Minying Gu
Elena Kraus
Bradley Nitta
New York University
School of Medicine
University of California
San Diego Medical Center
Jessica Petrone
Banner Good Samaritan Medical
Center-Arizona
University Hospitals
Columbia-Missouri
University of Texas
Medical School-Houston
Saint Louis University
School of Medicine
Richard Nguyen
Joshua Cheng
Scripps Clinic/Green
Hospital-California
Indiana University School of Medicine
Louisiana State University
School of Medicine-New Orleans
Saint Louis University
School of Medicine
University of Chicago
Medical Center-Illinois
FAMILY MEDICINE
University of Kansas
School of Medicine-Kansas City
Vinaya Mulkareddy
INOVA Fairfax Hospital-Virginia
Brandon Beal
Milap Dubal
Geoffrey Motz
Margaret Boyle
University of Kansas
School of Medicine-Kansas City
Cleveland Clinic Foundation
Loyola University
Medical Center-Illinois
Christine Liang
Advocate Christ
Medical Center-Illinois
DERMATOLOGY
Andrea Ziegler
PATHOLOGY-ANATOMIC AND CLINICAL
University of California
Riverside School of Medicine
Cynthia Morris
Rachel Huser
SUNY Upstate Medical University
Esther Kim
Matthew Mollman
University of Kansas
School of Medicine-Kansas City
OBSTETRICS AND GYNECOLOGY
Erica Sher
St. Vincent Hospital Center-Indiana
CHILD NEUROLOGY
Nicholas Pallo
Emory University
School of Medicine-Georgia
University of Illinois College
of Medicine-Chicago
University of Virginia
Vanderbilt University
Medical Center-Tennessee
Nabil Makhlouf
Banner Good Samaritan
Medical Center-Arizona
University of Pittsburgh
Medical Center Medical Education
Texas A&M Scott and White
John Mense
Cedars-Sinai
Medical Center-California
UCLA Medical Center-California
Emily Hanzlik
University of New Mexico
School of Medicine
Mark Zacharjasz
Loma Linda University-California
2015
Renata Medina
Bill Papagiannopoulos
University of Michigan
Hospitals-Ann Arbor
TRANSITIONAL YEAR
Jennifer van Lunteren
Teresa Micotto
Harvard Longwood
Psychiatry-Massachusetts
University of Tennessee
College of Medicine-Memphis
RADIATION ONCOLOGY
UROLOGY
Zachary Buchwald
Parth Patel
Emory University
School of Medicine-Georgia
Loyola University
Medical Center-Illinois
RADIOLOGY-DIAGNOSTIC
VASCULAR SURGERY
Erich Boomgarden
Indiana University School of Medicine
Thomas Herrin
Saint Louis University
School of Medicine
Zachary Wanken
Dartmouth-Hitchcock
Medical Center-New Hampshire
Saint Louis University School of Medicine 17
FAMILY TIES
GRATEFUL TO SAINT LOUIS UNIVERSITY FOR THE
PIVOTAL ROLE IT PLAYED IN HIS EDUCATION AND
MEDICAL CAREER, ROBERT KISTNER, M.D. (‘54)
AND HIS WIFE ADELAIDE KISTNER KNEW THEY
WANTED TO HELP FUTURE GENERATIONS OF
MEDICAL STUDENTS.
Kistner and Dean Alderson during
Reunion Weekend 2014.
David Miros, Jesuit Archivist, Central
United States, shows Kistner and his
wife, Adelaide, the Moses Linton Album,
which chronicles the work and travels of
Pierre-Jean De Smet, S.J. De Smet gave
the album to Kistner’s great-grandfather
as a gift.
TIMELINE
1842 Moses L. Linton, M.D.
becomes faculty at the school of
medicine and begins a 30-year career
of teaching at SLU.
1849 Cholera breaks out in St. Louis
and Linton is the house physician for
the Jesuit staff and student boarders
at SLU. No one dies from cholera under
his watch.
1850 Pierre-Jean. De Smet, S.J., a close
friend of Linton’s, presents Linton with
a personal scrapbook that chronicles
De Smet’s work and travels. The Moses
Linton Album remains one of the Jesuits’
most precious resources.
1851 Linton publishes his medical
essays in The Outlines of General
Pathology. Many chapters appeared
in The St. Louis Medical and
Surgical Journal.
1914 Linton’s grandson, Paul Frederick
Kistner, graduates from the school
of medicine.
1942 Linton’s great-grandson,
Paul Linton Kistner Sr., graduates
from the medical school.
1946 Linton’s great-grandson,
William Francis Kistner, graduates
from the medical school.
1954 Linton’s great-grandson,
Robert Linton Kistner, graduates
from the school of medicine.
18 GrandRounds
For them, paying it forward first involved
looking back on their family’s long heritage
in the medical school and broader University
community.
With research assistance from first-year
medical student Emma Dwyer, the Kistners
unearthed a family history that extends back
to Robert Kistner’s great-grandfather —
Moses Linton — one of SLU’s first medical
faculty members in 1842, and the founder
and editor of the Saint Louis Medical and
Surgical Journal.
“We always heard great things about
Moses, but hadn’t researched him before,
so it was a joy of discovery to see what he
accomplished and how his story wove into the
Linton-Kistner tradition that we were trying
to tie together,” Robert Kistner said.
The medical school helped the Kistners
create a physical timeline to document the
family’s many SLU connections, which include
Robert Kistner’s father Paul Frederick Kistner,
M.D. (1914) and all three of his brothers: Paul
Linton Kistner Sr., M.D. (’42), William Francis
Kistner, M.D. (’46), and John B. Kistner.
This exercise inspired the development of
the Kistner Family Medical School Scholarship Fund, initially supported by Robert and
Adelaide Kistner in collaboration with Elkin
Kistner, a son of the late William Kistner.
“The idea was that the scholarship would
be something shared by the family, which will
hopefully attract support from other family
members as they go through life,” Robert
Kistner said. “We also thought it might inspire
others to look into their own family ties with
the University.”
For Elkin Kistner, the scholarship provided an opportunity to honor his father’s legacy.
“I felt strongly about supporting the
scholarship, both as a gesture to my father
and to support an institution for what it had
done for members of my family,” said Elkin
Kistner, principal of the St. Louis law firm
Bick & Kistner PC. “I think my father needed
a little help, my Uncle Bob needed a little
help, and somebody else out there also needs
a little help.”
PAYING IT FORWARD
In 1947, Dean of Men Francis O’Hern,
S.J., made it possible for Robert Kistner to
remain at the SLU by offering him financial
support. “He convinced me to stay in school,
and I continued at Saint Louis University
for another 13 years, including completing
medical school and surgical training,” Robert
Kistner said.
To extend support to future generations of
undergraduate students, the Kistners also have
established the Robert and Adelaide Kistner
Medical Scholars Endowed Scholarship.
These new scholarships are a continuation
of the family’s support of the University, as
Adelaide Kistner’s parents established in 1997
the Josephine and J. Reynolds Medart Endowed Scholarship for students in the College
of Arts and Sciences.
And the family’s SLU academic connections continue with the two daughters of
Elizabeth Kistner Sueme (granddaughter
of Moses Linton) and John Joseph Sueme,
D.D.S. (A&S ’74, CADE ’84). Margaret Sueme
(E&PS ’13) graduated with dual majors in
history and education, and Catherine Sueme is
a sophomore majoring in public health.
FULL CIRCLE
Since 1966, Robert and Adelaide Kistner
have lived in Honolulu, where Robert Kistner
served as a vascular surgeon at Straub Clinic
and Hospital for nearly 40 years. Following his retirement in 2004, Robert Kistner
opened Kistner Vein Clinic, a practice he
continues to operate. He also is a clinical professor of surgery at the University of Hawaii
School of Medicine.
The Kistners returned to campus in
October 2014 to attend Reunion Weekend
and celebrate the 60th anniversary of Robert
Kistner’s medical school graduation.
“We were so impressed with the campus,”
Adelaide Kistner said. “The physical changes
to the University are just staggering, and
everybody was so upbeat. We had a wonderful time.”
And Robert Kistner was glad to witness
the University’s Jesuit mission in action.
“I treasure my Saint Louis University education because it put such an emphasis on life
values, morals and principles that really stand
up and are worth passing along,” he said.
“They’ve certainly been valuable to me.”
AlumniPulse
LIVING THE MISSION
A GIFT OF FAITH
ROBERT BUCHANAN, M.D. (’93), SAID HE IS TRULY BLESSED TO HAVE
FOUND A WAY TO ANSWER THE CALL OF HIS PROFESSION AND HIS GOD.
department of psychology at
the Dell Medical School and
the Institute for Neuroscience at the University of
Texas at Austin.
FOUNDATION OF FAITH
Buchanan is the son of
devoutly Catholic parents
who regularly invited priests,
Robert Buchanan, M.D., with Pope Francis.
ifornia San Diego when he
met the woman who would
become his wife. He found
other ways to serve God,
including staying active in his
diocese and serving on the
board of the National Catholic Bioethics Center. Buchanan also was invested into the
Sovereign Military Order of
Malta, a 1,000-year-old religious order of chivalry in the
Roman Catholic Church. He
presently serves as the order’s
area chairman of Texas.
K EEP IT SIMPLE
In 2013, Buchanan, was
appointed to the Pontifical Academy for Life. The
think tank is comprised of
120 physicians, scientists,
theologians and bioethicists
who communicate regularly
and meet annually at the Vatican to discuss the interplay
between faith, science and
medicine. Members analyze
issues within their realm of
expertise and advise the Holy
See on questions of medical
ethics in such matters as
procreation, palliative care,
IVF, gene therapy, euthanasia
and abortion.
Pope John Paul II established the academy in 1994,
and, before he retired two
years ago, Pope Benedict
XVI invited Buchanan to
serve. Buchanan is one of
only 12 members from the
United States.
“As physicians, we want
to heal and decrease suffering,” said Buchanan, chief
of functional and restorative
neurosurgery and neuroscience with the Seton Healthcare Brain and Spine Institute
in Austin, Texas. “Medical
breakthroughs allow us to
do more than ever, but just
because we can do something
doesn’t mean we should.”
Buchanan said, for example, that scientists are making
great strides in creating a
bionic hand. If scientists can
create such a hand, how far
can they go with enhancing a
person’s natural capabilities?
“At what point do these
advances impinge on God’s
beautiful design and purpose
for the human body, which
was created in His image?”
said Buchanan, who is also
an associate professor in the
cardinals and bishops into
their home. Buchanan
attended Catholic elementary
and high schools.
After earning his undergraduate degree at the University of Chicago, Buchanan, who strongly considered
becoming a Jesuit priest,
chose Saint Louis University
School of Medicine because
he wanted to immerse himself in his faith.
“I was impressed the
university had a chapel inside
its medical school,” he said.
“I went there daily. It was a
nice place to ground myself
and pray in the presence of
the Blessed Sacrament. Then
as now, faith permeates every
aspect of my life.”
Buchanan abandoned
his plan to become a priest
during his psychiatry residency at the University of Cal-
When the academy meets at
the Vatican, usually in early
spring, Buchanan could opt
to stay in a luxury hotel in
Rome. Instead he stays at the
Vatican’s sparsely furnished
guesthouse, Casa di Santa
Marta, which Pope Francis
uses as his official residence.
Buchanan has seen the Pope
in the hallways and spoken to
him briefly at lunch.
“I think Pope Francis has
energized the Church and has
brought us back to Christ’s
original message of unconditional love,” he said. “He
has changed the tenor of the
conversation, so rather than
talking about the sin we’re
reaching out to the sinner.”
Members of the academy
are appointed for five-year
terms, but most members
remain as long as the Vatican
feels they have something
to contribute. In addition
to serving on the academy,
Vatican officials recently
asked Buchanan to be the
Holy See’s representative on
The Lancet Commission on
Global Surgery, an international panel of experts
working to make surgery
in low- and middle-income
countries a priority on the
global health agenda.
Buchanan said he is humbled daily by the faith the
Church has placed in him.
Saint Louis University School of Medicine 19
From Your Alumni
Association President
saint louis university
EDWARD J. O’BRIEN JR., M.D. (’67)
MED
reunion
Weekend 2014
Members of the class of 1989 posed with Pestello and his wife, Fran (far left), during the Reunion dinner.
Also pictured is the Rev. James Tobin, S.J., medical center campus minister from 1979 to 1993.
Howard Schlossman,
M.D. (’39), shared
his medical school
memories with
current students
during the Dean’s
Welcome Reception.
With the recent dedication of the
Edwin Everest Education Union I am
reminded of the building’s mission.
It was designed to bring together
students and educators from all health
care-related disciplines – medicine,
nursing, allied health, graduate dental
O’BRIEN
education, public health and ethics –
to help us realize how much common ground we share.
“Union” implies team and the team approach is embraced
by today’s health care system.
The School of Medicine is doing an exceptional job
of instilling team concepts in its graduates. Through the
the Center for Interprofessional Education and Research
based in the education union, students are learning to
coordinate care and collaborate with colleagues in order to
improve patient care delivery and outcomes. Most importantly, they are learning that patients are a critical part of
that team. As you will read in this issue of Grand Rounds,
teamwork and patient-centered care are the guiding forces
behind our abdominal transplant team. The article on our
cultural competency curriculum details how students are
learning to relate to and understand patients from various
socio-economic and cultural backgrounds.
As graduates of the medical school, we should be
proud that our school is in the forefront of addressing
health care changes in many areas. The recent rebranding
of the professional practice as the SLUCare Physician
Group refreshes our continuing health care commitment
and mission.
As always, stay current with the Medical Alumni Association. Update your location and contact information if
your situation changes. We would enjoy hearing from you.
In Memoriam
Students prepare to demonstrate the use of a fully automatic, high-fidelity patient
simulator as a part of their medical training during the reunion CME Program.
20 GrandRounds
From left, Philip O. Alderson, M.D., dean of the School of Medicine; Thomas
Ahlering, M.D. (’79), 2014 Alumni Merit Award recipient; and Edward J. O’Brien Jr.,
M.D.(‘67), president of the School of Medicine Alumni Association. Ahlering is an
internationally recognized expert in urologic oncology, robotic surgery and men’s
health. He is vice chairman of the department of urology at the University of
California-Irvine School of Medicine and a professor in the division of oncological
urology. Ahlering holds two patents in his field, is the author of more than 275
scientific publications and has lectured worldwide. He is a member of several
editorial boards including the Journal of Urology and the Journal of Endourology.
Ahlering has been listed among “America’s Best Doctors” for the past 20 years.
Arthur Starr, M.D. (’44)
Leo Figiel, M.D. (’46)
Warren Johnson, M.D. (’47)
James Phipps, M.D. (’47)
Hubert Ritter, M.D. (’48)
Gerald Stark, M.D. (’48)
Joseph Hinkamp, M.D. (’50)
Harry Raitano, M.D. (’52)
William Sullivan, M.D. (’53)
Robert Hill, M.D. (’54)
Ireland Kimball, M.D. (’54)
Paul Ritter, M.D. (’54)
J. Thompson, M.D. (’54)
Donald Coleman, M.D. (’55)
SCHOOL OF MEDICINE ALUMNI EVENTS
May 7 John H. Gladney, M.D., Diversity Award Reception
May 9 Dr. James Swierkosz Scholarship Golf Tournament
Aug. 2 White Coat Ceremony
Note: Each month,
the School of Medicine
sends emails to alumni
about reunion weekend. If
you are not receiving e-mail
updates from the School
of Medicine about reunion
weekend, please send an
email to [email protected]
and share your name, class
year and email address.
Dean May, M.D. (’57)
Bernard DeLeo, M.D. (’58)
Richard Roland, M.D. (’58)
Anthony Czerwinski, M.D. (’59)
Domingo Baitlon, M.D., (’60)
Cornelius Hogan, M.D. (’60)
William Kuhn, M.D. (’60)
Robert Jones, M.D. (’72)
John Nelson, M.D. (’72)
David Petreccia, M.D. (’81)
Cheryl (Herzwurm)
Sisler, M.D. (’84)
Randall Robyn, M.D. (’90)
Garrett Hagen, M.D. (’92)
October 15 – 17
Medical Reunion Weekend
Celebrating the classes of 2010, 2005, 2000,
1995, 1990, 1985, 1980, 1975, 1970, 1965,
1960, 1955 and earlier.
FOR INFORMATION:
314-977-8335 medschool.slu.edu/alumni/
CONTINUING MEDICAL EDUCATION PROGRAMS
May 22
5th Annual SLU Jeffrey Modell Foundation Conference
CME Course of Primary Immunodeficiency Diseases
Advanced Retroperitoneal Anatomy of the Pelvis
with Focus on Pelvic Neuroanatomy and Complication
May 28-30
Prevention in Minimally Invasive Surgery in
Endometriosis, Urogynecology and Oncology*
June 16-17 ER Skills
World Federation of Athletic Training and Therapy,
June 20-22 2015 World Congress: Overuse Injury in Sport;
An Interprofessional Approach
July 20-23
Masters Medicolegal Death Investigators
Training Course
July 24-26
Cosmetic Blepharoplasty and Fundamentals
of Face Lift
July 31- Aug. 1 Foot and Ankle Arthroscopy*
Aug. 7 St. Louis Area Concussion Symposium
Aug. 15 Resident Update in Rhinology
Aug. 20-22
Innovative and Advanced Surgery of the Degenerative
and Deformed Lumbar Spine*
3rd Annual SLU Department of Neurosurgery
Aug. 27-30 Combined Ventricular and Skull Base Endoscopy
Course for Neurosurgeons*
Sept. 10-12
DECEASED ALUMNI
President Fred Pestello offers welcome remarks during the annual reunion celebration dinner.
MARK YOUR CALENDAR
22nd Advanced Techniques in Cervical Spine
Decompression and Stabilization
Sept. 18-19 8th Annual Stroke Conference
Oct. 16-17
R econstruction After Major Head
and Neck Ablative Surgery
Oct. 21-24 Microsurgery of Aneurysms: Recent Advances
Oct. 26-30 Medicolegal Death Investigator Training Course
Nov. 4-6
Craniofacial Surgery and Transfacial Approaches
to the Skull Base
Nov. 6-7 Techniques in Foot and Ankle Reconstructive Surgery*
Nov. 12-15 Endoscopic Ear Surgery and Advanced Otology Workshop
Nov. 19-22
Hair Transplant 360 Cadaver Workshop and Follicular
Unit Extraction Workshop*
*denotes hands-on cadaver workshop
FOR INFORMATION:
314-977-7401 medschool.slu.edu/cme/
Non-Profit Org.
U.S. Postage
PAID
St. Louis, MO
Permit No. 134
1 N. Grand Blvd., Salus 609
St. Louis, MO 63103
“As graduates of Saint
WE INVITE YOU
TO JOIN THE
Louis University’s School of
Medicine, we all share many
of the same experiences
and memories – late nights
of studying, early morning
anatomy labs as well as
celebrations following those
tough exam weeks. I support
the School of Medicine to
honor where the foundations
of my medical practice were
built and to provide the
same experience for future
generations of students.”
ANNE CHRISTOPHER, M.D. (’94)
PAIN MANAGEMENT
With benefits designed
exclusively for supporters
of the School of Medicine,
the White Coat Society
celebrates partnerships
between the medical
school and alumni.
Annual contributions
of $2,500 or more to
any School of Medicine
fund grant membership
in this prestigious circle,
with tiered membership
levels for graduates of
the past 15 years; giving
at the $2,500 level also
grants membership to the
President’s Circle Giving
Society, which honors
leadership donors across
the entire University.
For more information, visit giving.slu.edu/WhiteCoat or call 314 -977-9302.